Between 1850 and 1950, allopathic medicine attained and then enjoyed unprecedented autonomy and dominance, becoming the premiere example of a profes- sion. In its battles for status with its many 19th-century rivals, allopathic medicine benefited from the public’s growing respect for scientific knowledge and from the increase over time in the field’s scientific foundations. It also benefited from the public’s assumption that because allopathic doctors were disproportionately upper-class white men, they must be more competent than the minorities, women, and poorer persons who dominated competing health care fields. Since the 1950s, however, doctors’ social status has declined, and their control over working conditions, relationships with patients, and finances has diminished. Yet doctors continue to have far more autonomy and dominance than do professionals in most other occupations, especially within the health care field. This continued professional dominance—and the continued internecine warfare between medicine and other health care occupations—affects all of us as consumers of health care because it sets the stage on which attempts to improve the health care system must occur. Among other things, as Chapter 12 will show, medical dominance has made it difficult for alternative health care modalities to receive adequate research testing or for tasks to be shifted, when medically justified, from doctors to less expensive occupational groups.
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